Abstract: Treatment of Urinary Incontinence Associated with Pelvic Floor Muscle Weakness

Sandra F. Reilley, MD, FACOG. "Treatment of Urinary Incontinence Associated with Pelvic Floor Muscle Weakness." Journal of Pelvic Surgery 8 (May 2002) 3: 131-40.

Objectives:
To determine the effectiveness of behavioral therapy, particularly biofeedback-assisted pelvic floor muscle rehabilitation, in treating urinary incontinence.

Methods:
To determine their eligibility for behavioral therapy, incontinent patients were evaluated by means of a medical and incontinence history and a physical examination. The evaluation included a review of medications and social factors, a bladder and bowel diary, a neurologic assessment, an abdominal exam, a thorough pelvic/rectal exam, assessment of mobility, standard laboratory tests such as urinalysis, and measurement of post-void residual (PVR) using the BladderScan^® Bladder Volume Instrument.

Of the patients who were evaluated, 270 entered pelvic floor muscle rehabilitation and behavioral therapy (PFMR-BT). Stress UI was the primary diagnosis in 41%, urge UI in 44%, and mixed UI in the remaining 15%. The PFMR-BT program used combined biofeedback-assisted PFM exercises, bladder retraining, dietary modification, bladder emptying techniques, a bowel regularity program, and coping strategies for stress and urge.

Results:
70% of the patients who entered therapy completed the program. The only difference between completers and non-completers was in their cognitive ability to understand the program and independent personal motivation.

76% of the patients who completed the program were cured of UI, 15% were significantly improved, and 8% continued to suffer moderate to severe incontinence. Follow-up evaluations showed that after 2 years, patients continuing to exercise daily maintained the improvements continence.

Conclusions:
When treated with pelvic floor muscle rehabilitation and behavioral therapy, patients with UI related to pelvic floor muscle weakness have a high cure rate (76%). This method of therapy demonstrates both short and long-term effectiveness. Furthermore, the patient prefers behavioral therapy because it is noninvasive. Behavioral therapy also has the fewest potential adverse complications when compared to pharmacologic and surgical methods of treatment. Reilley writes, "The first choice of therapy should be the least invasive treatment with the fewest potential adverse complications that is appropriate for the patient." She advocates more widespread use of PFMR-BT for patients whose incontinence is related to pelvic floor muscle weakness.

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